Provider Demographics
NPI:1558032755
Name:CODY, DANIEL DALTON (RN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DALTON
Last Name:CODY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8276 COUNTY ROAD 304
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-5708
Mailing Address - Country:US
Mailing Address - Phone:386-283-3309
Mailing Address - Fax:
Practice Address - Street 1:8276 COUNTY ROAD 304
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-5708
Practice Address - Country:US
Practice Address - Phone:386-283-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9551655163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice